Western World Countries Research Articles

Cytogenetic Alterations and Correlation with Age and Gender in Patients of Multiple Myeloma: A Study from a Tertiary Care Center in Eastern India.

Karuna JhaBackground Multiple myeloma is a cytogenetically heterogeneous, evolving, and incurable disease. Differences in prevalence of myeloma already exist in Indian subcontinent as compared with Western world countries. This study attempts to investigate differences in incidence of cytogenetic abnormalities (CA) in Eastern Indian patients and study differences in incidence with respect to age and gender. Materials and Methods Interphase fluorescence in situ hybridization (FISH) was applied on purified plasma cells of 280 newly diagnosed myeloma cases using specific probes. Statistical Analysis Data was analyzed using SPSS software version 25. Results Note that 51.07% patients were FISH positive. Del13q was the most common CA. Significant association of del 13q with t(4;14), del 17p, and gain of 1q was seen. The frequencies of FISH positive and negative groups differed in the different age groups; higher number of cases in 41 to 50 years group in FISH positive group ( p < 0.05) and lower number of cases in FISH positive group in 61 to 70 years ( p < 0.05) as compared with FISH negative group. Del 17p had higher number of cases in age group 41 to 50 years and 51 to 60 years as compared with other age groups. Incidence of t(11;14) was in 5th to 7th decade while del 13q and t(4;14) had the widest range of age at presentation. Gender disparities were seen in high-risk cytogenetics like del 17p and 1q gain. Conclusion The differences in incidence rate of CAs per se in myeloma cases diagnosed in Indian subcontinent and the differences in incidence with respect to age and gender warrant further multicentric studies.

Of print and scholarship: deconstructing the literature on printmaking in contemporary Nigerian art

Printmaking has long been in use, especially among indigenous art practitioners in Nigeria, it is also very popular among contemporary Nigerian artists who use it as a medium of aesthetic expression. The foundation for scholarship on printmaking was laid by notable scholars; however, writing from their cultural context, a sizable number of these scholars follow the perspectives that confined contemporary printmaking to the Western world and Asian countries. Considering the prolific production of printmaking in Nigeria, this study deconstructs the literature to understand the state of scholarship on printmaking, especially in contemporary Nigerian art. Data collected from published journal articles, books, exhibition catalogues, and Internet sources were subjected to critical analysis. The study concludes that printmaking in Nigeria is so unique that it would continue to attract the attention of art enthusiasts around the globe; hence, it deserves more attention from African art historical scholars.

Incidence Trends of Inflammatory Bowel Disease in a Southern European Country: A Mirror of the Western World?

INTRODUCTION:Inflammatory bowel disease (IBD) affects people from all age categories worldwide. Although the incidence of the disease is stabilizing or decreasing in most Western world countries, its prevalence is still increasing because of the rise in life expectancy and better disease management. This work intends to identify the trends related to IBD incidence nationwide, analyzing regional, sex, and age distributions.METHODS:Data were provided by the Portuguese Shared Services of the Ministry of Health. This study consisted of a retrospective analysis of all first consultations coded for “Chronic enteritis/ulcerative colitis” (D94) in a primary healthcare setting, between 2017 and 2020, in Portugal. The primary outcome measure was the IBD incidence rate per 100,000 inhabitants. We also calculated the incidence rate per person-year and forecasted incidence until 2024.RESULTS:Between 2017 and 2019, the incidence rate of IBD in Portugal decreased from 54.9 to 48.6 per 100,000 inhabitants. The average incidence was 20 new cases of IBD per 1,000 person-year. It was predicted that, in December 2023, IBD incidence would reach 305.4 new cases (95% Prediction Interval 156.6–454.3), a similar result to the values forecasted for December 2021 (305.4, 95% Prediction Interval 197.3–413.6).DISCUSSION:The incidence of IBD slightly declined from 2017 to 2019, and it is posed to stabilize in the future. The presented data are of the utmost importance for the characterization of IBD in Southern European countries and the establishment of future health policies in the setting of compounding prevalence in the Western world.

GEOGRAPHIC DIFFERENCES IN THE RISK OF SURGERY IN INFLAMMATORY BOWEL DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract BACKGROUND The management of inflammatory bowel disease (IBD) is associated with considerable healthcare and societal cost. A key driver of direct medical cost, remains surgery. Although the cumulative risks of surgery have been well described in countries of the Western world, surgical risk data from Asia, where IBD is rapidly emerging, is lacking. OBJECTIVES The primary objective was to compare the cumulative risk of surgery at 1-year after a diagnosis of Crohn’s disease (CD) and ulcerative colitis (UC) between contemporary adult population-based cohorts from the Western world and Asia. Secondarily, we estimated 5- and 10-year risks of IBD-related surgery. METHODS MEDLINE and EMBASE were searched for population-based studies published on or after January 1, 2000, that reported 1-, 5-, and 10-year risks of IBD-related surgery. Authors were contacted to provide previously unpublished data. Random effects models were performed to analyze temporal and regional risks of surgery for cohorts diagnosed with IBD in the year 1998 and later. RESULTS The initial search yielded 10,358 citations. Of those, 37 studies were used in analyses. For UC, the 1-, 5-, and 10-year risk of surgery were 1.71% (95% confidence intervals [CI]: 1.13, 2.29), 3.77% (95% CI: 2.41, 5.13), and 8.33% (95% CI: 5.03, 11.63), respectively. For CD, the 1-, 5-, and 10-year risk of surgery were 7.17% (95% CI: 5.92, 8.42), 13.63% (95% CI: 11.26, 16.00), and 24.57% (95% CI: 19.21, 29.93), respectively (Table 1; Figure 1). For CD, the 1-year risk of surgery was 7.44% (95% CI: 6.07, 8.80) and 7.22% (95% CI: 2.65, 11.78) for countries in the Western world and countries in Asia, respectively (p= 0.93). The Western 5-year risk of CD surgery (13.52%, 95% CI: 10.85, 16.19) was similar to Asia (15.95%, 95% CI: 5.48, 26.43) (p=0.66). The 1-year risk of surgery for UC was not significantly different between Western world countries (1.87%, 95% CI: 1.27, 2.47) and Asia (0.74%, 95% CI: -0.48, 1.97) (p=0.13). The pooled 5-year risk of surgery was significantly higher in countries of the Western world (4.13%, 95% CI: 2.71, 5.55) as compared to Asia (2.11%, 95% CI: 1.88, 2.33) (p=0.02). Comparison of pooled 10-year risk between countries of the Western world and Asia was not possible as there was only one Asian study published on risk of surgery 10-years after CD and UC diagnosis each. CONCLUSIONS During the 21st century the risk of early surgery 1-year after the diagnosis for CD and UC was similar in countries of the Western world as compared to Asia. Long-term (10-year data) was lacking for Asian countries. Future studies are needed to generate more robust long-term estimates for risks of IBD-surgery in Asia.

MELAKA AS A FOOD TOURISM DESTINATION IN MALAYSIA: DOMESTIC TOURIST EXPERIENCE

Melaka was awarded as a World Heritage Site by UNESCO on 7 July 2008 due to 500 years of development and its role in trading and cultural exchange between Eastern and Western world countries in the Straits of Melaka. The rich history makes Melaka a multi-ethnic cultural heritage and historical tourist destination in Malaysia, mainly food. This study aims to identify the variety of local food in Melaka offered to tourists and review the experience of domestic tourists in Melaka, specifically in food eaten, eatery locations, and foods brought as souvenirs. A total of 297 respondent participated in this study, and a convenience sampling method was applied. The result showed that 65 different menus and drinks from Malay, Chinese, Indian, Baba-Nyonya, and Portuguese ethnic enjoyed by domestic tourists. Malay food is the primary choice of most respondents, while asam pedas (spicy sour) is the most favourite food among tourist. Most domestic tourists enjoy local food at restaurant and market/street food accessible around Melaka city. Dodol, a type of Malay sweets, was the most purchased food as a souvenir.

The Epidemiology and Genetics of Hyperuricemia and Gout across Major Racial Groups: A Literature Review and Population Genetics Secondary Database Analysis.

Gout is an inflammatory condition caused by elevated serum urate (SU), a condition known as hyperuricemia (HU). Genetic variations, including single nucleotide polymorphisms (SNPs), can alter the function of urate transporters, leading to differential HU and gout prevalence across different populations. In the United States (U.S.), gout prevalence differentially affects certain racial groups. The objective of this proposed analysis is to compare the frequency of urate-related genetic risk alleles between Europeans (EUR) and the following major racial groups: Africans in Southwest U.S. (ASW), Han-Chinese (CHS), Japanese (JPT), and Mexican (MXL) from the 1000 Genomes Project. The Ensembl genome browser of the 1000 Genomes Project was used to conduct cross-population allele frequency comparisons of 11 SNPs across 11 genes, physiologically involved and significantly associated with SU levels and gout risk. Gene/SNP pairs included: ABCG2 (rs2231142), SLC2A9 (rs734553), SLC17A1 (rs1183201), SLC16A9 (rs1171614), GCKR (rs1260326), SLC22A11 (rs2078267), SLC22A12 (rs505802), INHBC (rs3741414), RREB1 (rs675209), PDZK1 (rs12129861), and NRXN2 (rs478607). Allele frequencies were compared to EUR using Chi-Square or Fisher’s Exact test, when appropriate. Bonferroni correction for multiple comparisons was used, with p < 0.0045 for statistical significance. Risk alleles were defined as the allele that is associated with baseline or higher HU and gout risks. The cumulative HU or gout risk allele index of the 11 SNPs was estimated for each population. The prevalence of HU and gout in U.S. and non-US populations was evaluated using published epidemiological data and literature review. Compared with EUR, the SNP frequencies of 7/11 in ASW, 9/11 in MXL, 9/11 JPT, and 11/11 CHS were significantly different. HU or gout risk allele indices were 5, 6, 9, and 11 in ASW, MXL, CHS, and JPT, respectively. Out of the 11 SNPs, the percentage of risk alleles in CHS and JPT was 100%. Compared to non-US populations, the prevalence of HU and gout appear to be higher in western world countries. Compared with EUR, CHS and JPT populations had the highest HU or gout risk allele frequencies, followed by MXL and ASW. These results suggest that individuals of Asian descent are at higher HU and gout risk, which may partly explain the nearly three-fold higher gout prevalence among Asians versus Caucasians in ambulatory care settings. Furthermore, gout remains a disease of developed countries with a marked global rising.

Surgical management of hepatolithiasis: an institutional experience of a rare disease

Hepatolithiasis remains as a rare condition in the majority of western world countries. Although genetic, dietary and environmental factors have been associated with the disease, the exact etiology of this entity remains elusive. Several approaches; surgical and non-invasive have been well described. However, surgery remains the standard of care for definitive treatment of the disease. We sought to present the recent experience of our clinic regarding the surgical management of hepatolithiasis in the backgound of a narrative literature review. All adult patients with hepatolithiasis admitted to our center during the period 2018 to 2020 were included in the study. Patients’ demographics, comorbidities and preoperative characteristics were collected by chart review. All patients underwent open left lateral hepatectomy. Three cases with hepatolithiasis were identified. All of them were male and had been suffering from recurrent pyogenic cholangitis. All patients remained asymptomatic and disease-free through the entire follow-up, except one case that was complicated with bile leakage during the immediate postoperative period. Hepatolithiasis is currently a rare condition in the western world. Surgery is safe and effective treatment approach for refractory cases and, provided that it is performed by experts in hepatobiliary surgery, it remains imperative for the definitive treatment of the disease.

Towards the Spirit of Renewal and Openess: The Roman Catholic Church Reforms and the Global South

The Second Vatican Council (1962-1965) has brought change into the Roman Catholic Church. Since that day, various changes has taken place within the Roman Catholic Church. Furthermore, the Roman Catholic Church which has always been associated with the Western world, especially European and North American countries, is and will face the "Global South" phenomenon. Some recent studies have shown this real shift. This study will try to present how the “Global South” phenomenon occurs, and what’s the role of the Roman Catholic Church and also local Church, as well as the opportunity to grow and developed more. Discussing also how the Roman Catholic Church which has been built from a fairly long tradition for around two millennia will face the situation of its universality and also at the same time its diversities and localities as the Church becomes increasingly dominated by Catholics in the Global South region. Some of ideas are the Church should embraces Global South, increasingly develop the spirit of renewal and openness, and the most important thing is to involving the participation of local Church in South Countries to overcome social issues that occurs or we called it a Participatory Church.

Why I March?

The tale is as old as time, women have been fighting for their rights for centuries. Their lives have always been restricted, and the rationale is unelucidated. They constantly face inequality in the society, be it in the western world or more conservative countries of the world. It never came easy for women; they not only had to raise voice for the basic rights which their counterparts are already endowed with.&#x0D; In 1913, first big rally was arranged by Woman Suffrage Procession, it was the first big public meeting in Washington D.C. for sanction voting for women in the entire country of United States of America. The March was attended by many women and sadly the March was attacked by police of Washington State, injuring around 300 women. The state police also mentioned “There would be nothing like this happen if you would have stayed at home”. Even though in some states of USA, women were permitted to vote since 1869 however, the entire country did not get the right to vote until 1919, which was a big achievement for the women globally. Women of USA and Europe have had many public gatherings to increase awareness about importance of being an equal citizen in the society.&#x0D;

Does teaching about artificial reefs trigger students’ situational interest in marine biology?

ABSTRACT The lack of interest among pre-university students to choose STEM subjects for their higher education is a heavily debated issue in many western-world countries. To boost Danish students’ interest in biology, a study event on artificial reefs was introduced when teaching marine biology in lower secondary school and upper secondary school (student age 13–20 years). The purpose was to investigate if the focus on artificial reefs could generate an increased interest in natural science and marine biology among the students. The students’ interest in science was evaluated using electronic questionnaires before and after they had completed the teaching programme. The students were significantly more interested in natural sciences and marine biology after than before the teaching program. The development in situational interest in science and in the oceans was different for males and females with females being most interested. Thus, it is possible to trigger a situational interest for science and marine biology by teaching about artificial reefs, but the way interest is triggered differs between different age groups and sexes.

Human papillomavirus as an independent risk factor of invasive cervical and endometrial carcinomas in Jordan

BackgroundEndometrial and cervical carcinomas are the most common gynecologic malignancies in Western world and many countries. The human papillomavirus (HPV) high-risk genotypes are associated with cervical carcinoma (CC). Chlamydia trachomatis (C. trachomatis), the most common sexually transmitted bacterial infection worldwide, considered a cofactor for HPV infection and CC. Information on HPV infection rate and type distribution among Jordanian women having CC is currently limited and unavailable among those with endometrial carcinoma. Therefore, the present study aimed to provide an updated estimate on HPV infection rate and its high-risk genotypes' distribution among Jordanian women by comparing data from invasive cervical carcinoma (ICC) to normal cervical tissues. Similarly, assessment of HPV infection rate was extended to the endometrial tissues. C. trachomatis infection was investigated as well to explore its possibility as HPV cofactor for induction of such carcinomas. MethodsTotal DNA was extracted from 144 formaldehyde-fixed paraffin-embedded cervical and endometrial tissue, equally divided between age-matched control and carcinoma cases. Polymerase chain reaction (PCR) was used for general detection of HPV-DNA, high risk HPV-16 and 18 genotypes and C. trachomatis DNA using specific primers. ResultsHPV infection was detected in 91.7% and 61.1% of cervical cancer patients and controls, respectively. Likewise, it was higher among cases (47.2%) than controls (13.8%) in endometrial biopsies. Significantly higher HPV infection rates were found among ICC and endometrial control biopsies of women >50 years. Out of 33 HPV positive ICC cases, single HPV-16 infections were detected in 69.7% compared to HPV-18 (15.2%), while HPV-16/18 co-infections were only found in three (9%) samples. C. trachomatis was not detected in all studied groups. ConclusionThe present study has successfully provided an updated estimate on HPV infection rate among Jordanian women with and without ICC and endometrial carcinoma. In addition, a lack of co-infection was observed between HPV and C. trachomatis in both cancer types.

Lumbar spine surgery across 15 years: trends, complications and reoperations in a longitudinal observational study from Norway

BackgroundStudies from different Western countries have reported a rapid increase in spinal surgery rates, an increase that exceeds by far the growing incidence rates of spinal disorders in the general...

The Protagonism of the USSR and Socialist States in the Revision of International Humanitarian Law

Abstract The USSR and Socialist states played a crucial and still largely underappreciated role in the re-negotiation of international humanitarian law (IHL) in 1949 and 1977. Drawing on new multi-archival research, I demonstrate that the support of the Soviet Union and Socialist Bloc states was essential to the negotiation of key legal achievements with regard to non-traditional conflict forms and actors, including rules on internal conflicts, national liberation war, and irregular fighters. They exerted influence chiefly through concerted action to create or side with majority coalitions alongside neutral Western or Third World countries, forcing their principal Western foes to accept rules they found undesirable. Yet Soviet-Western interactions in the re-making of IHL were not simply confrontational. In the 1970s, as Cold War hostilities cooled, East and West engaged in partial backdoor cooperativeness, leading to critical features of the Additional Protocols I and II, including rules for the protection of civilians and IHL oversight.

Götz Hillig and his search for the true Makarenko. What did he find?

Beginning in the twenties of the previous century, the writings of Anton Semjonovitch Makarenko, an educator who was born in the Ukranian part of the former Russia and mainly spoke and wrote in Russian, attracted much attention among educators not only in the Russian-speaking world and in communist states but also in the Western world and other countries. He lived from 1888-1939, which means that the bulk of his writings were published in the Stalinist period of the Soviet Union. The most detailed investigations into his writings and professional and private life were accomplished by the West German researcher Götz Hillig (born 1938) at the University of Marburg. He dedicated his professional life to the famous educator and produced a critical edition of Makarenko’s important works together with a multitude of analyses and commentaries covering most of the disputed questions regarding his life and work. To most of them he found a convincing answer. So far, Hillig’s immense, yet diversely published work has not been explored to see which new picture of Makarenko can be drawn from Hillig’s scrutiny. He himself did not finish this task as he focussed on delivering a fully clarified basis of texts and a complete history of Makarenko’s life. This article underpins the necessity of drawing conclusions from Hillig’s works and gives a first idea of the change in our picture of Makarenko which flows from Hillig’s work.

Ageing, longevity and fitness: towards new paradigms in healthy ageing

We have nearly reached the end of the second decade of the Millennium. Within 5 years we hope the Third Ageing Summit will be held to discuss lessons learned and future directions in the field of Ageing and Longevity. 1) I mention the word Longevity since many countries especially in the Asia Pacific region, the second Hub of Ageing after the Western world countries, have experienced this phenomenon since the early years of this Millennium.

A clinical guideline on Dientamoeba fragilis infections.

Dientamoeba fragilis (D. fragilis) is an intestinal parasite frequently detected in humans with abdominal pain and diarrhoea, but it is also commonly found in asymptomatic subjects. Hence its clinical relevance is often disputed. The introduction of polymerase chain reaction (PCR) is a versatile and sensitive diagnostic technique for the detection of intestinal parasites, and in some Western world countries PCR has almost completely replaced microscopic diagnostics. PCR has however resulted in an increase in the number of D. fragilis-positive patients. The disputed pathogenic nature of this intestinal parasite and an apparent increase in the incidence of patients with positive PCR results have renewed the discussions between clinicians and microbiologists on how to deal with an infected patient. Moreover, treatment guidelines differ throughout the world which makes it difficult for clinicians to choose an optimal therapeutic regimen.AimTo summarize and discuss the current knowledge on the pathogenicity, best diagnostic approach, treatment and follow-up of children and adults infected with D. fragilis.

Genetics of Cardiovascular Disease: Fishing for Causality.

Cardiovascular disease (CVD) is still the leading cause of death in all western world countries and genetic predisposition in combination with traditional risk factors frequently mediates their manifestation. Genome-wide association (GWA) studies revealed numerous potentially disease modifying genetic loci often including several SNPs and associated genes. However, pure genetic association does not prove direct or indirect relevance of the modifier region on pathogenesis, nor does it define within the associated region the exact genetic driver of the disease. Therefore, the relevance of the identified genetic disease associations needs to be confirmed either in monogenic traits or in experimental in vivo model system by functional genomic studies. In this review, we focus on the use of functional genomic approaches such as gene knock-down or CRISPR/Cas9-mediated genome editing in the zebrafish model to validate disease-associated genomic loci and to identify novel cardiovascular disease genes. We summarize the benefits of the zebrafish for cardiovascular research and highlight examples demonstrating the successful combination of GWA studies and functional genomics in zebrafish to broaden our knowledge on the genetic and molecular underpinnings of cardiovascular diseases.

Physical and Psychological Violence against Married Men in District Dir (Lower), Khyber Pukhtoonkhwa, Pakistan

The World Health Organization [1] has defined violence as “the intentional use of physical force, threatened or actual, against oneself, another person, or against a group or community, that either results in, or has a high likelihood of resulting in injury, death, psychological harm, mal-development or deprivation’’ [1]. According to the WHO [1] typology of violence, there are mainly three types, such as, self-directed, interpersonal, and collective violence; these types are further divided into subtypes [1]. The current study focused on interpersonal (intimate partner or domestic) violence against married men. The Intimate Partner Violence (IPV) can be defined as the physical, psychological, or sexual harm by current/previous partner or spouse; domestic violence is used interchangeably with IPVs [2]. Violence against women is extensively studied in different parts of the western world and Asian countries; however, very few of the researchers have paid attention towards violence against men [3,4]; Hines et al. [5] it is commonly claimed that men are traditionally viewed as being physically stronger than women, therefore, they under-report their victimization due to barriers like embarrassment and masculine ego [6]. The fact that men are victims of IPV, from their female partners, has been identified for the last thirty years [5]; these victims often face the humiliation of being laughed at, accused, belittled, or ridiculed, due to which they do not report their victimization [6]. Studies have identified equal levels of exposure to intimate partner violence among men and women [7]; the rates and frequencies of violence enacted by women are often similar to that of their men partners [8]. Such symmetry signifies a weak association of gender with perpetration of IPV. However, men’s ego has been developed by the society in such a way that their reporting of violence is generally considered a social stigma. When men attempt to report DV against them, most of the times they are not trusted; instead, they are laughed at and ridiculed for the notion that they are beaten by their wives

Fear of cancer recurrence and social support among Indonesian gynecological cancer survivors

Background: Fear of cancer recurrence is a long-term psychological problem of the cancer survivors regardless of the type of cancer. A growing number of studies had addressed fear of cancer recurrence, yet they are largely focused on the breast cancer survivors of the western world countries. This study investigates the fear of cancer recurrence and its relations to social support in Indonesian gynecological cancer survivors. Methods: Gynecological cancer survivors (n = 153) in Samarinda, East Kalimantan, Indonesia completed Fear of Cancer Recurrence Inventory, Interpersonal Support Evaluation List, socio-demographic and clinically-related characteristics questionnaires. Pearson r correlation tests, t-tests, and ANOVAs were used to identify the relationships between variables, and linear regression to determine to what extent the social support may predict the survivors? fear of recurrence. Results: Indonesian gynecological cancer survivors with higher social support were more likely to experience lower levels of fear of cancer recurrence. Whereas, having a family history of cancer was an important predictor of fear of cancer recurrence levels. Conclusion: Social support plays an essential role in predicting fear of cancer recurrence among Indonesian gynecological cancer survivors.

Sömürgeciliksonrası dönem romanlarında yabancılaşma unsurunun temsili: Salman Rushdie'nin Utanç ve Janet Frame'in bir başka yaza doğru romanları

Colonialism, which is the settlement movements and implementation of the political and economic exploitation ideology of the Western and Northern 1st World countries that were thought to be more powerful than the Eastern and Southern 3rd World countries, started in the ancient times and went on until the mid-20th century. As a result of the decoloniztion movements, beginning after World War II and with India in 1947, colonized countries historically started to be denominated as post-colonial. While the term post-colonial refers to the time after decolonization, the term postcolonial, without hyphen, refers to the cultural consequences or conditions of post-colonial period. During the decolonization process, the postcolonial individual felt the loss of the sense of belonging, marginalization, and alienation. Postcolonial literature, reecting these senses felt by the postcolonial individual, questions the colonial process and challenge the colonial discourse. In this study, Pakistan and New Zealand, gaining their independence in 1947, are studied as post-colonial countries, and the sense of alienation of post-colonial Pakistani and New Zealander individuals, who are either in their home countries or in the host countries to which they emigrated, is depicted mostly with its negative connotations. The alienation which is felt by Rushdie's Pakistani and Frame's New Zealander narrators in his Shame and in her Towards Another Summer is also felt by the other characters in the novels. In this sense, the aim of this study is to delineate, also by mentioning the positive meaning of alienation, that in a postcolonial literature a postcolonial individual is depicted as the one feeling alienated mostly in its negative context although alienation, as a notion, has both positive and negative meanings.